OBJECTIVE The purpose of this investigation was to characterize the bone health in preoperative spine surgery patients. This information will provide a framework to understand the needs and methods for providing bone health optimization in elective spine surgery patients. METHODS A retrospective study of 104 patients undergoing bone health optimization was performed. Patients were selected based on risk factors identified by the surgeon and suspected compromised bone health. Evaluation included history and examination, laboratory investigations, and bone mineral density (BMD) at 3 sites (femoral neck, lumbar spine, and radius). Patients’ bone status was classified using WHO criteria and expanded criteria recommended by the National Osteoporosis Foundation (NOF). The 10-year Fracture Risk Assessment Tool (FRAX) scores of the hip and major osteoporotic fracture (MOF) were calculated with and without femoral neck BMD, with spine BMD, and with the trabecular bone score (TBS). Antiresorptive and anabolic agents were provided in accordance with meeting NOF criteria for treatment of osteoporosis. RESULTS The mean patient age was 69.0 years, and 81% of patients were female. The mean historical height loss was 5.6 cm, and 54% of patients had a history of fracture. Secondary osteoporosis due to chronic renal failure, inflammatory arthritis, diabetes, and steroid use was common (51%). The mean 25-hydroxy vitamin D was 42.4 ng/ml and was normal in 81% of patients, with only 4 patients being deficient. The mean T-scores were ?2.09 (SD 0.71) of the femoral neck, ?0.54 (1.71) of the lumbar spine, and ?1.65 (1.38) of the distal radius. These were significantly different. The 10-year FRAX MOF score was 20.7%, and that for hip fracture was 6.9% using the femoral neck BMD and was not significantly different without the use of BMD. The FRAX risk-adjusted score using the lumbar spine BMD and TBS was significantly lower than that for the hip. Osteoporosis was present in 32.1% according to WHO criteria compared with 81.6% according to NOF criteria. Antiresorptive medications were recommended in 31 patients and anabolic medications in 44 patients. CONCLUSIONS Surgeons can reliably identify patients with poor bone health by using simple criteria, including historical height loss, history of fracture, comorbidities associated with osteoporosis, analysis of available imaging, and calculation of FRAX score without BMD. High-risk patients should have BMD testing and bone health assessment. In patients with osteoporosis, a comprehensive preoperative bone health assessment is recommended and, if warranted, pharmacological treatment should be started.
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机译：目的对本调查的目的是在术前脊柱手术患者中表征骨骼健康。这些信息将提供一个框架，以了解在选修脊椎手术患者中提供骨骼健康优化的需求和方法。方法采用骨骼健康优化104例患者的回顾性研究。根据外科医生确定的危险因素选择患者，涉嫌受损的骨骼健康。评估包括3位点（股骨颈，腰椎和半径）的历史和考试，实验室调查和骨矿物密度（BMD）。使用国家骨质疏松症基础（NOF）推荐的谁的标准和扩展标准进行分类，患者的骨骼状态。髋关节和主要骨质疏松骨折（MOF）的10年骨折风险评估工具（Frax）评分用脊柱BMD和脊柱BMD和小梁骨分数（TBS）计算。根据满足骨质疏松症的NOF标准提供反孔和合成代谢剂。结果平均患者年龄为69.0岁，81％的患者是女性。平均历史高度损失为5.6厘米，54％的患者有骨折历史。由于慢性肾功能衰竭，炎症性关节炎，糖尿病和类固醇使用引起的继发性骨质疏松症是常见的（51％）。平均25-羟基维生素D为42.4 ng / ml，在81％的患者中正常，只有4名患者缺乏。平均t分数是股骨颈的2.09（SD 0.71），腰椎的0.54（1.71），α1.65（1.38）的远端半径。这些显着不同。 10年的Frax Mof得分为20.7％，并且对于股骨颈BMD的髋部骨折为6.9％，而不会有明显的不同BMD。使用腰椎BMD和TBS的Fax风险调整分数显着低于臀部的分数。根据NOF标准，根据世卫组织标准，骨质疏松症以32.1％的标准存在于32.1％。在31名患者中，建议在31名患者和合成代谢药物中进行抗血液药物。结论外科医生可以通过使用简单标准可靠地识别骨骼健康状况差的患者，包括历史高度丧失，骨折史，与骨质疏松症相关的合并症，可用成像分析，以及无BMD的计算。高风险患者应具有BMD测试和骨骼健康评估。在骨质疏松症患者中，建议综合术前骨骼健康评估，如果有保证，应开始药理学治疗。
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